Ins and Outs, Part 2

In this second story of our two-part series, our heroine Ethel finds that it even more difficult to get OUT of the place where she had such a hard time getting IN…

When Mom called early Tuesday morning, I was already on the couch drinking coffee and reading the news online.

“I don’t know a thing yet,” she said. “And I tried to call Daddy again and he didn’t answer. Probably doesn’t have his hearing aid in.”

“I went over to check on him a few minutes ago and he was already outside.  I’m sure he didn’t take the phone with him.”

“Oh, no, he wouldn’t even think of carrying the phone,” she said. “And if he did, he’d lose it. Well, I’ll call you as soon as I know something.”

I told her I planned to be there about 10. “Oh, don’t rush,” she said. “If they turn me loose before you get here, I’ll just put on my clothes and wait for you. I’ve still got my book to read.”

“Did you read last night?”

“No, I watched TV. Two episodes of Law and Order.”

At 10:00, I called her back to tell her that I was running later than I intended and was just about to leave the house.

“They are right now getting me ready to go down,” she said. “They’re trying to start the IV for the dye so I’ll probably be gone when you get here.”

“Trying?” I said. “Are they having trouble?”

“Oh, yeah,” she said, “Nurse called somebody up to get it. She couldn’t get it.”

“Okay, I better let you go. See you after the test.”

I took my time getting on the road. I was in the room forty minutes when she got off the gurney. It was 12:10.

“Thanks,” she said to the man wheeling her bed. “That didn’t take long at all.”

“Give me my pills,” she said after a trip to the bathroom. “You did bring them, didn’t you? Here it is after noon and I haven’t even had my morning pills.”

I handed over the daily pill sorter and she swallowed the entire contents of the Tuesday section with one gulp of water. “And don’t give them to those nurses because I’m about to go home,” she said. “They said they wanted me to let them give me my pills.”

“Guess it’s too late now,” I said.

“Well, they took my Flagyl and Cipro.”

“But they did bring it to you, right? You should have had some last night and this morning.”

“Oh, yeah, and they got me some Percocet last night since I didn’t have mine here. There’s no telling what that will cost.”

Nurse and Trainee came in not long after to hook her back up to the IV, explaining that they were pushing fluids to flush the dye from her system. I wasn’t there because Mom had already sent me to the food court. I might have mentioned that I had two more tickets to use.

“I’m starving,” she said. “He gave you four?”

“Oh, my goodness, you haven’t had anything to eat since midnight. Is there anything you don’t want?”

“I don’t want any baked chicken. No baked chicken.”

“They won’t have baked chicken today,” I said. “They had the baked chicken yesterday. Everything will be different today. I’ll just see what looks good.”

I chose one box of barbecued chicken breast on polenta, braised greens, and roasted carrots. The carrots looked so good I added them to the second box of herbed tilapia and spinach soufflé.

“I see they hooked you back up to your drip,” I said, un-stacking my four boxes.

“They say they’re pushing fluids to flush the dye out of my system,” she said.

“That makes sense. Dessert is banana pudding. It looks good, but you just can’t tell about banana pudding made in bulk.” I pulled a bottle from my pocket. “I brought you  some apple juice.”

Mom held the small container of dessert to her chest. “It’s warm. I better taste it.”

“Before your tilapia?” I asked.

“Yes.”

I handed her a spoon.

“It’s good,” she pronounced after two mouthfuls. “Good stuff. I better go to the bathroom before I eat.”

Nurse and Trainee answered the call.

“Well, that IV is working, isn’t it!” Trainee said.

“And—you’re good to go home,” Nurse said, as Mom, Trainee, and IV pole made their way to the potty. “We’re just waiting for someone from Dr. Scoville’s office to sign off on the discharge papers.”

“Do you have any idea when that will be?” I asked.

“No, they’ll just come by as soon as they can. I’m not sure. We’ll let you know. We just called them.”

Nurse and Trainee came back in after we finished eating.

“Did you bring her meds with you?” Nurse asked.

“Yes,” I said.

“I took them already,” Mom said, just as I was saying, “She took them right after she got back to the room.” I figured I would just fess up to what could be considered as incompliant.

Nurse acquired a frown. “Sweetie, you were supposed to give them to us.”

“Actually, we thought she was on her way home so that it wouldn’t matter,” I said. I said “we” to distribute the guilt.

“She’s not supposed to take them herself.” She sighed. “What did she take?” she asked in a noticeably exasperated tone.

“She took every morning med that is listed in her record.” I knew that because I was the one who gave the admissions nurse the meds list to put in the record.

“What all is that?” she asked.

I reached for the list I in the top of my bag. I looked up to see that Nurse had a pencil and paper poised to begin writing.

“Okay, let’s see, she had Diovan, bumetanide, propranolol, nefedipine…”

Nurse snickered and shook her head and said, “Wait, wait. Okay. She had the Procardia?”

I said, “Propanolol.”

She answered me, “No, Sweetie, Procardia.”

“Oh,” I said. “That’s the nefedipine. Procardia is nefedipine, isn’t it? She did have that.”

“Well, see, now, she wasn’t supposed to have that Bumex. They didn’t want her to have that Bumex—and that’s why we’re supposed to do this.”

“Okay, but she’s already taken this stuff now. I’m thinking there were morning meds she wasn’t supposed to take, you know, before the test, like when she would normally take her morning meds? She didn’t have her meds here before the test.” If I had felt more confident in the conversation, I would have said, “It’s okay. There, there.”

She gave me what Mom calls a “blank stare”.

“Well, anyway,” I said, “she probably needs you to be very clear and specific—if there’s something she isn’t supposed to take.”

“Oh, we told her we needed her medications,” she said, her manner of speaking saying,“We did what we were supposed to do so don’t blame us”.

“That may not be the same thing as telling her last night that there were some morning meds she wasn’t supposed to take this morning,” I mumbled as Mom overrode me.

Mom bolted upright in the bed. “They’re gone!” she said, spreading her hands palms up and opening her mouth to show it empty. “It’s done. I took them.”

They heard her. I think everybody heard her—even ten doors down the hall.

Time to divert attention. “I really can give you all this,” I said, waving the list. “I know what she takes every morning. Simvastatin, Prevacid, aspirin…”

“I take the simvastatin at night,” Mom said, turning to me.

At the same time, Nurse said, “Simvastatin? She took simvastatin?”

“No,” I answered. “ No, it was just next on this list and I was reading down the list. She takes that at night. Sorry.”

“Ewwwww-kay,” Nurse answered. She jotted something on her note.

“And then there’s that big handful of vitamins,” I said. “Calcium, D, E, C Garlic, B12, glucosamine.”

This time the response was more of a huff. “Okay,” she said, and tucked her pencil in her pocket and turned to leave. Trainee was standing behind her this time, so Trainee had to go first.

“I’m not sure I get that,” I said—as soon as I was sure they were gone. “I think they’re talking about what you weren’t supposed to take before the test this morning—and you didn’t—because you didn’t have your pill box here.”

“I don’t get it, either,” Mom said. “I’m not sure they know what they’re doing. They’re just kids.”

“There is a marked difference between the staff on this floor and the one you were on last,” I said. “What floor was that, anyway?”

“Can’t remember. But I told them this morning that I would just skip my morning pills and take them when I got home. What difference does it make if I took them here at 1 o’clock or home at 3 o’clock?”

“I don’t know. I’m sleepy.”

We both settled for naps. “May as well nap while we wait on Scoville’s nurse,” Mom said.

“Let’s play Banana-grams after our naps,” I told her.

“I don’t know how.”

“I don’t either, because I always play with Jameson and Carly and they make up their own rules. We’ll figure it out.”

I was first to wake up; I picked up my e-reader. Mom continued to snore for another half hour or so.

“You had a good nap,” I said, closing the cover on my Kindle.

“You did, too, when you weren’t snoring,” she said. “I have to go to the bathroom again.” She pushed her call button and Trainee arrived.

“We can disconnect that tube as soon as you’ve finished this bag,” Trainee said on the way to the bathroom.

“Well, at least then I can move around and not be calling you every ten minutes,” Mom said.

“Oh, no. If you’re going to get up, you need to call us to help you. We don’t want you to fall,” Trainee said. I was totally in agreement but I didn’t say anything.

“No word from Scoville’s office yet?” Mom asked.

“Not yet,” she answered.

“I’m going to call Scoville’s office,” Mom said after she got back in bed. I was just about to lie to her and tell her that I didn’t have the number when she started punching numbers. “I know the number,” she said.

She left a message and then said, “I should have asked for the nurse.” She dialed again and punched the number for Dr. Scoville’s nurse. She left another message.

“Mom, I’m not even sure they’re in the office. You said today is the day he goes to Carthage. Maybe his nurse here doesn’t even work in Nashville today. I don’t know.”

“Well!” Her indignation swelled. “How is anybody ever supposed to know if they’re coming or not? This beats all I’ve ever seen…”

“Mom, there’s always a chance that they’re not waiting for his nurse to actually come over here and sign papers. I mean, why wouldn’t they be able to do all that electronically these days?”

“Who knows…” she answered. “We’re waiting on something. Or somebody.”

“Yep, but it’s possible that we’re just waiting on what has to happen here. Maybe they just needed you to finish that IV bag of fluid before you could leave. They said they needed to flush out your system…”

“Nobody said a thing about that,” Mom said. “And the IV’s been finished. I’m ready to get out of here.”

“Any word yet?” I asked Nurse when she came in the room to look at the IV.

“No, not yet, Sweetie,” was the answer. “But we can take this tube loose from your IV,” she said to Mom. “You finished off that bag.” She clipped off some little thing on the needle, released the tube, and coiled it on a hook at the top of the pole.

She left the room and returned with Trainee.

“We’re going to need to get her medications from you so that we can figure out what all she took,” Nurse said.

I knew she planned to read the labels on pill bottles and write down the ones with instructions to be taken in the a.m. I hated to tell her what she was up against; I tried to make light of it. I held up the Daily AM/PM Pill Sorter and winced as I handed them over.

“Good luck.” It was all I could think of to say right then.

I heard a combination of a sigh, a blow, and a grunt. She took the container from me.
“Sweetie,” she addressed Mom, and then turned to me, “We’re not trying to be mean. We just need to know and do what we’re supposed to do and we are the ones who are supposed to give her her medications.”

“I know,” I said. “I understand. She took her own Flagyl and Cipro before, so I just figured she’d take her own medications that she missed this morning.”

“But we are giving her the Flagyl and Cipro,” Trainee said. “That’s why we took them.”

“I guess I figured all that was over with since she was about to be discharged.”

“Well, she’s not discharged yet. We need to administer the meds as long as she is here.”

“I know. I know,” I said.

Nurse moved so that she was shoulder-to-shoulder with Trainee. Then she launched into a small speech. “We’re really not trying to be mean. We are concerned about doing our jobs, and keeping you safe, and I promise, we’ll bring these back. We are just doing our jobs.”

I cut her off. This time, my tone would betray my otherwise innocuous words. “Really, you don’t have to give us a customer service treatment. We do understand.”

“Okay.” They turned to the door in tandem. “We’ll come back in a few minutes to take the IV’s out.”
“There’s more than one IV in your arm?” I asked.

“Yeah, that one for the dye is over here on the outside of my elbow.”

“See, Mom,” I said. “They’re still fiddling with your chart. They’re working on your medications list.”
“Hmph,” is all she said.

We talked for only a few minutes when Trainee came in to pull out the IV needles. She stooped to the floor beside Mom’s left arm.

“You know, of course, the part that hurts the worst is removing this tape.”

Just as she pulled out the first IV, Nurse entered the room. Trainee dropped the gauze she intended to use. “Could you hand me some gauze?” she asked.

In just a few minutes, the needles were out and the two entry sites were padded and taped.

“That’s probably going to bleed a little, but I padded it pretty good,” Trainee said.

“Oh, it usually does,” Mom said.

“We’ll be back as soon as we get the go-ahead,” Nurse said.

After several minutes, I said, “Mom, we can leave now. And I think we’ll give them until 5 o’clock and then we will leave, discharged or not.  I just need to find somebody to bring us some papers to sign. I’ll step out in the hall and tell them.”

“Good,” she said. “And don’t forget, we have to get my medicine back.”
Several doors down the hall, a male nurse was writing on a chart just outside another patient’s room. A female staff member approached him from several feet away and the two began what seemed to be a tense exchange about a phone call from a doctor, some necessary paperwork that the nurse was trying to finish, and whether he could stop what he was doing to do whatever it was that she wanted him to do. He couldn’t; I understood that much.

I eased back inside Mom’s room.

“What did you tell them?” Mom asked.

“Actually, I didn’t see either of our nurses, and it looked like the two I did see were in the middle of an issue of some kind. They were sort of snappy with each other; I didn’t want to butt in.”

She sighed.

“Well, I’m going to call to go to the bathroom again. And then you can tell her.”

This time, a nurse-technician came to help.

I called her by name, “Meredith” (not her real name), “I need you to tell our nurse that we are going to leave and that we will be happy to sign papers.”

“You want to leave AMA?” she asked. “AMA” stands for “against medical advice”.

“Yes, we do,” I said. “I told her we could go home at 5 o’clock.” It was 4:50.

She flushed the toilet. “Okay,” she said.

Nurse and Trainee entered the room just two minutes before 5:00. Meredith followed closely behind.

“We were just coming in to get you going,” Nurse said.

I nodded. “And you’re here directly after we threatened to leave AMA.”

“Oh, no,” Nurse shook her head. “That’s not what happened. We were coming anyway. We just got finished up. It’s not what happened.”

“Well, you can’t say that you didn’t come to discharge her right after we asked to leave AMA. That did happen.”

“Oh, yeah, I guess so, but it had nothing to do with it.”

Trainee added, “We’ve just been busy.”

“Oh,” I said. “What happened?”

“Well, one thing and then the other. We have other patients we were tending,” Nurse said.

I nodded.

“And…and, we had a patient fall. A patient fell. We had a hard time getting him up. It took us a while.”

“Oh, my,” I said. “But she got back to this room at 12:10. It is now after 5 o’clock.”

“Well, we’re going to get you out of here. Trainee is going to do your education.”

Trainee told Mom to resume all her regular medications, just as usual, and to keep the bandages on the IV sites, and not too much else. She pointed to the bottom left of one sheet. “It says here for you to follow up with Dr. Scoville on the 26^th—That’s in two days.”

“No,” Mom said, “It says to follow up with Scoville on 7/26. That’s July. That’s my regular appointment with him. July.”

“Oh, yeah. I read that wrong. July 26. And here are your medications.” I took the pill sorter and the two bottles of antibiotics and dropped them into Mom’s bag.

“Okay,” Nurse said. “I think you can get dressed to go.”

She looked at me. “Oh, we couldn’t have let her go any earlier. We just got the papers signed about an hour ago.”

“So we could have left an hour ago?”

“Well, no, it takes about an hour to do all the paperwork.”

“Really?”

“Yes, about an hour. Well, do you have any questions?”

“No,” I said, “We do not have questions, but I do have a lot of resentments. I know that this whole fiasco may not be your fault, but you’re the one standing in front of us. I’ll be happy to complete a survey if you like. St. Thomas, bar none, has to be the worst experience we’ve ever had with hospitals. Scoville is the only reason we’re here at St. Thomas. If it weren’t for Scoville, we would not come to St. Thomas ever again.”

“Ohhhhhhhh, no, really?” Nurse asked. “What could we do…?”

“You know, we told you it took 2 ½ hours to get into this place. Well, now it has taken us double that, plus more, to get out. It’s ridiculous…” I didn’t seem worthwhile to go on to re-live the rest of the visit. I just wanted to get Mom into the van and leave.

“Noooo,” Nurse said. “I am so sorry, Sweetie. We take our jobs very seriously and we try very hard.”

“I’m sure you do,” I said. I did not want to say more. “And if all this is because you’re short-handed, I’m sorry that St. Thomas can’t seem to get you some help.”

“And we care for our patients,” she said. “We really do.”

I nodded. “I do not know what is wrong here, but it’s something within the system. We have experience with other hospitals in town and they’re both smaller—one a community hospital—and the other, people look down their noses at, but they’re both more efficient…they’re better operations than St. Thomas.”

“I hope you’ll come back,” she said.

“I’m sure we will, whether we want to or not,” I said. “This is where Scoville is.”

I helped Mom dress. She brushed her hair and put on some lipstick.

“Mom, they usually bring a wheelchair, you know. I didn’t hear her say anything about that, though.”

“I can get there with Dolly. I’m not in bad shape.”

They caught us at the door.

“We need to take you downstairs,” Nurse said.

“Not necessary,” Mom said. “I do not need a wheelchair. I’m just fine.” She rolled on.

“Trainee,” Nurse said, “Would you go down with them?”

“Where are you parked?” she asked me.

“I’m in the visitor’s garage,” I said. “I’ll take Mom to the discharge area, get the van, and then I’ll pick her up.”

“Okay,” Trainee said, “I’ll just wait with her.”

Mom turned to me as we drove off the hospital campus. “Well, Sweetie, we’ve managed to hit the work traffic again.”

“We sure have,” I said.

I still don’t mind when Mom calls me Sweetie.

***